Category: Dystonia: Clinical Trials and Therapy
Objective: To systematically analyze the stimulation parameters of the subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with dystonia.
Background: DBS is widely used in the treatment of dystonia, and the STN is one of the most frequently used targets. The stimulation parameters are needed to be optimized to achieve satisfying results . However, there are no recommended stimulation parameters for STN DBS, here we analyze the parameters used in literature.
Method: In the Pubmed/Medline database, we searched for the literature of STN DBS stimulation parameters in dystonia. Based on the 2013 classification of dystonia, we classified the dystonia into four types: generalized isolated dystonia, generalized combined dystonia, focal and segmental dystonia, and acquired dystonia.
Results: In the 86 publications retrieved from Pubmed/Medline, 24 were included while 62 were excluded for no individual stimulation parameters provided. The data of 24 publications contains 94 patients and 160 electrodes. The averaged stimulation parameters were: 2.59 V ± 0.67 V in amplitude, 83.87 μs ± 34.70 μs in pulse width, 142.08 Hz ± 37.81 Hz in frequency [table1]. The averaged improvement rate is 64.72 ± 24.74 %. In the data of all types of dystonia (160 electrodes), the improvement rate and stimulation parameters were linear dependent (F = 16.489, P <0.01). The improvement rate increased by 3.58% for every 10Hz frequency increase. In the focal and segmental dystonia (78 electrodes), improvement rate and stimulation parameters were linear dependent (F=12.055，P<0.01). The improvement rate increased by 6.06% for every 10Hz frequency increase and decreased by 2.14% for every 10 μs pulse width increase. 17 publications (83 patients) mentioned stimulation-related adverse effect: dyskineisa (transiant: 15, sustained: 2), depression (8), transient dysarthria (5), weight gain (4), transient dysphasia (3), transient paresthesia (2), sustained hyperkinesia (2).
Conclusion: The most benefiting stimulation parameter of STN DBS varies in each patient. Our analysis may provide a recommendation of programming in the specific type of dystonia, especially for the patients of focal and segmental dystonia. This review also highlights the importance of complete data reporting in the literature.
To cite this abstract in AMA style:Y. Wang, C. Zhang, B. Sun, D. Li, Y. Wu. Stimulation parameters of subthalamic deep brain stimulation in dystonia: a systematic review [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/stimulation-parameters-of-subthalamic-deep-brain-stimulation-in-dystonia-a-systematic-review/. Accessed November 29, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/stimulation-parameters-of-subthalamic-deep-brain-stimulation-in-dystonia-a-systematic-review/